Candace Benson

Individual provider Active NPI Registered Dietitian · Lawton, OK

NPI 1699106963 · NPPES record last updated Dec 11, 2013

Key facts

NPI
1699106963
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
1747 (OK)
Practice address
105 NE 52ND St
Lawton, OK 73507-7371
Phone
(405) 659-5717
NPI assigned
Dec 11, 2013
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1747OKMDPhysician Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1747 OK Yes

Addresses

Primary practice location

105 NE 52ND St
Lawton, OK 73507-7371

Mailing address

105 NE 52ND St
Lawton, OK 73507-7371

Other providers in Lawton, OK

All providers in Lawton, OK · Registered Dietitian in Oklahoma

Sources for this page

Verify at the official NPI Registry.